Diabetes Diagnosis Doesn’t Stop Athletes From Competing

October 11th, 2008

I totally freaked out. I cried for days,” says ultra-marathoner Missy Foy. She was certain her career was over when she was told a decade ago that she had type 1 diabetes.

Foy, now 42, had the misfortune of being diagnosed at a time when doctors were still in the dark over how to help athletes continue their careers after being told they had diabetes. Foy visited four endocrinologists before finding a doctor who would help her balance her insulin while continuing to compete.

“Most doctors didn’t have any experience with [competitive athletes],” Foy says. “They thought it would be too difficult to balance insulin and the intensity of training.”

Although exercise is often prescribed as a way to manage type 2 diabetes, athletes with type 1 face special challenges. In people with type 1, exercise can cause blood sugar levels to drop precipitously. Therefore, exercise, food intake and insulin injections must be carefully monitored and balanced.

Fortunately for athletes with diabetes, a lot can change in 10 years. In the past, America’s most popular diabetic was probably Mary Tyler Moore. Today, the public face of diabetes includes basketball players, long-distance swimmers and triathletes.

Today, new technology has made it easier for athletes with diabetes to stay on the field without having to think constantly about the disease. Continuous glucose monitors can track blood sugar and sound alarms if it goes outside of safe ranges. Wireless insulin pumps can deliver insulin as needed without a morass of tubes and wires.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, says that in the past, he would have discouraged a patient from intense athletic competition. “Now,” he says, “I want kids with diabetes to be empowered to take care of themselves and to know and believe that there are no impediments before them.”

In April, Denver Broncos quarterback Jay Cutler, 25, announced that he’d been diagnosed with type 1 diabetes. Doctors emphasized that in no way was his football career jeopardized. He joins Olympic swimmer Gary Hall Jr., LPGA golfer Kelli Kuehne, Colorado Rockies pitcher Jason Johnson and Charlotte Bobcats forward Adam Morrison—among many others—as an active professional athlete with the disease.

The evolution of self-monitoring has allowed athletes to continue their careers. Years ago, type 1 patients would check their glucose by testing their urine, which did not provide instantaneous feedback.

These days, an athlete can draw a drop of blood to be read by a meter, which gives results in real time. Insulin pumps communicate wirelessly with glucose meters the size of matchboxes to determine blood sugar levels. Results tell athletes if they should eat more food, ease up or take in insulin.

This was hardly the case 25 years ago, when Phil Southerland’s mother was told that her 7-month-old son would have “renal failure or blindness…if he lives to 25.”

Today, Southerland is the founder of Team Type 1, a cycling team of eight type 1 diabetics. In 2007, the team won the 3,053 mile “Race Across America,” completing the Los Angeles-to-Atlantic City competition in 5 days, 15 hours and 43 minutes.

For Southerland and his teammates, a typical race day is much like that for any other cyclist, except that they are constantly monitoring their blood sugar levels. Every 15 minutes or so during the two hours before the start of the race, they have to check their levels and sometimes have to use food or insulin to adjust because of the importance of being at the correct level once the race begins.

Southerland says regulating glucose levels is still a matter of trial and error.

Although exercise is often prescribed as a way to manage type 2 diabetes, athletes with type 1 face special challenges. In people with type 1, exercise can cause blood sugar levels to drop precipitously. Therefore, exercise, food intake and insulin injections must be carefully monitored and balanced.

“If we have too much insulin on board before the race, we’ll bonk immediately,” he says. “If our blood sugar is too high, we won’t perform our best, and if it’s too low, we won’t perform at all.”

Southerland says he checks his blood sugar 18 to 25 times a day. “We are essentially the CEOs of our own bodies and we don’t get a break from them,” he says.

Team Type 1’s ultimate goal is to have a team composed entirely of athletes with diabetes compete in the Tour de France in four to six years.

“It’s important for the parents of small children with diabetes to know they don’t need to put limitations on their families and their children,” says Type 1 team member Fabio Calabria, 25. “If they put in a little extra work and get everything under control, they can do whatever they want to do and they can do it as well as anyone else.”

When Ironman triathlete David Weingard, 43, was told he had type 1 seven years ago, he had nowhere to turn. His doctor discouraged him from doing another triathlon, he said.

Weingard found that unacceptable. He would continue to be active, he decided, but he would be meticulous about it. He spent one year training for his first post-diagnosis Ironman, simulating the experience down to the time the gun would flare at the starting line, then compiled the information in a 50-page document.

“I figured out what it’s like to go in the pool at exactly the time the race would start, to test myself during the swim, then to come out and see how much insulin I needed to take,” he says. “I learned what my routine would be every single hour.”

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Blood & Honey: A Doc About Diabetes

October 10th, 2008

What do an African medicine man, a diabetes researcher, a feminist philosopher, and a Native American psychologist have in common? They are all part of a new documentary, now in production, dealing with the psychological component of living with diabetes.

I was in the middle of my dissertation on diabetes when the idea for this documentary hit me. As someone with type 1, I wanted to understand how living with the condition for so many years influences people’s identity development. This question became the topic of my dissertation and led me in surprising directions.

As I delved into the research in this area, I realized that diabetes researchers focus primarily on the negative aspects of living with diabetes. Few researchers talk about how people can develop in positive ways as a result of dealing with this kind of adversity. I knew from personal experience that it isn’t true that diabetes has only a negative effect. So I turned to literature that discussed the other side of living with illness. Some was written by people who actually had chronic illness, and some was written by people who had explored the issue of suffering.

I discovered two writers who really changed the way I thought about diabetes. They came from completely different backgrounds, but they were actually saying the same thing.

The first person was well-known African medicine man Malidoma Patrice Some’, whose book, The Healing Wisdom of Africa, was assigned to me in graduate school. In Malidoma’s tribe, a crisis, such as a diagnosis of diabetes, is viewed as an initiation to a new phase of growth. Instead of being seen as a horrible disaster, a diagnosis is perceived as an opportunity to develop greater wisdom.

It Takes a Village

Malidoma feels that in order to successfully make it through a crisis, we have to draw on community and elders. He asserts that people can be elders at any age as long as they have developed a certain level of maturity and wisdom. He views people who have lived with a chronic illness like diabetes for many years as elders.

The other writer who influenced me was philosopher Susan Wendell, who has lived with chronic fatigue syndrome for the past 20 years. Dr. Wendell believes that when people with chronic illness spend many years developing wisdom about how to deal with pain and suffering, they become a valuable resource for people both with and without chronic illness. She explains, “We don’t talk as much about the experience of illness as we talk about how to get over it, how to stop it, how to prevent it, how to relieve it, how you can be healthy if you really try. We don’t look inside the suffering, past the wall of suffering, to see what’s behind it. I think there’s an enormous body of knowledge out there, among people who are suffering, that is untapped, and if we could tap into it more, we’d be less afraid, and we’d know more how to cope when it happens to us.”

These ideas were amazing to me because they are so different from how we usually view illness. Coming to see myself as someone with wisdom to share was a revelation. Our culture focuses so much on the negative side of illness and suffering. Usually when I tell someone that I’ve lived with diabetes for 36 years they respond by saying “I’m so sorry” or “You poor thing.” Nobody has ever thought to pick my brain and find out what I’ve learned about the issues that are not only at the heart of diabetes but are also common to us all—uncertainty, loss, change, and mortality.

Documenting Diabetes

With these ideas in mind, I began the process of making a documentary about diabetes. I wanted to share the perspectives about illness of people with type 1 and type 2, as well as those of various psychologists, philosophers, and chronic illness scholars.

The film takes viewers through the journeys of three people who have lived with diabetes for 20 or more years. We refer to these individuals as “diabetes elders”—people of different ages who have acquired a wealth of knowledge and experience that can be passed onto others. We hear what it was like in the beginning when they were first diagnosed and then how they progressed through the years. The people with diabetes share not only what they’ve learned about living with the condition, but also what they’ve learned about life.

The project has gotten off to an exciting start with our first seven interviews, which include Malidoma Patrice Some’ and Susan Wendell. We recently completed our second shoot, and the whole production team was riveted by the interviews.

An image from the filmAn image from the film

You Can Help Complete the Film

This project depends upon tax deductible donations. In order to continue filming, we must raise more funds. If you are willing to help get this film completed, there are many ways you can contribute. You can make a tax deductible donation through www.bloodandhoney.org.

You can also help by organizing a fundraiser or by connecting us to people interested in donating. We are also planning a music fundraising event, and we welcome introductions to musicians who might be willing to participate.

This is a non-profit endeavor. If the film generates more revenue than it costs to produce, I will donate the majority of the funds to starting diabetes support groups through the San Francisco branch of the Juvenile Diabetes Research Foundation.

Find out more about Blood & Honey

Jessica Bernstein, PsyD, is a psychologist who has a private practice in Berkeley, California, with a focus on people with diabetes. She can be contacted at jessica@bloodandhoney.org.

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Sit! Roll Over! Diagnose Hypoglycemia! Good Dog!

October 9th, 2008

In a report published in the December 23, 2000, issue of the British Medical Journal (BMJ), researchers at the University of Liverpool in the United Kingdom write that hypoglycemia is one of the complications of diabetes most feared by patients. They point out, “Intensive research has been devoted to the development of hypoglycemia alarms.”

However, one thing we in the diabetes community might be overlooking is good ol’ reliable Rover.

In addition to being used by law-enforcement officials for sniffing out drugs and explosives, dogs are capable of guiding visually impaired people, as well as recognizing fits in people with epilepsy. The U.K. researchers believe that canine companions could also very well be the solution we have been looking for to detect low blood sugars, describing them as both “non-invasive” and a “fully bio-compatible and patient-friendly alarm system.”

“Hypoglycemia alarm dogs could provide an important aid to patients with poor awareness of symptoms, particularly those prone to [night-time] episodes or who live alone,” the BMJ paper stated.

The BMJ paper is not the first to address this phenomenon. In a 1992 issue of Diabetic Medicine (volume 9; supplement 2; S3-S4), researchers at the Bristol and Berkley Health Centre in Gloucestershire studied 50 people with diabetes who had owned pets since starting insulin. Thirty-eight percent of the people who owned dogs said their pooch responded to their hypoglycemic episode, by either barking or fetching a neighbor. This led the researchers to conclude, “Pets may help patients with type 1 diabetes through aiding them when hypoglycemic.”

Three Case Studies

In the paper prepared for BMJ, three diabetic women (whose reports were volunteered spontaneously and independently) and their faithful canine companions were evaluated.

Dog Hides Under a Chair When Owner Goes Low

The first case study involves a 66-year-old woman who developed type 2 diabetes in 1971. According to the BMJ paper, the woman was transferred to insulin in 1979 and currently takes injections of Regular and NPH twice daily, for a total of 38 units per day.

Despite having no significant diabetic complications or other illness and drinking very little alcohol, the woman reportedly has experienced “increasingly frequent hypoglycemic episodes the past two years,” commonly characterized by excessive sweating, generalized weakness, anxiety, and irritability. Most attacks occur in the evening, and some occur at night.

The 66-year-old woman during the past year has noticed, “unusual stereotyped behavior” by her nine-year old female mutt, Candy, prior to her having a low-blood-sugar episode. Candy’s behavior includes jumping up and down, running out of the room, and hiding under a chair in the hallway. Candy then re-emerges when the woman has taken a carbohydrate. The woman notes her BGs during such episodes are around 27 mg/dl.

“Wake up,” says Little Susie

The second case study involves a 47-year-old type 2 woman who takes 28 units of insulin each day. The woman has about two low-blood-sugar episodes per week, commonly characterized by sweating and sometime confusion. Her lows tend to occur during the afternoon and sometimes at night.

Within the past year, the woman’s seven-year-old female mutt, Susie, has shown “peculiar behavior during the patient’s hypoglycemic attacks.” The woman reports that Susie has nudged her awake. After awaking, the woman has tested to find herself having low blood sugar, usually around 36 mg/dl. Susie goes back to sleep only after the woman has taken a carbohydrate and her symptoms have settled.

Scratching the Bedroom Door

The third case study involves a 34-year-old type 1 woman who has suffered from retinopathy and kidney complications. She currently takes NPH and lispro, totaling 41 units per day. On average, she has two hypoglycemic episodes per week, characterized by sweating and light-headedness. The BMJ paper reports the woman has, “reduced awareness of hypoglycemia and does not wake up during nocturnal episodes.”

The woman’s three-year-old male golden retriever, Natt, becomes very distressed whenever she is hypoglycemic. During episodes of night-time hypoglycemia, he barks and scrabbles against the bedroom door and stops only after the woman’s hypoglycemia has been corrected. For the BMJ paper, the woman notes that her BGs on two such occasions were 29 and 34 mg/dl.

Taking Glucose Sensing to New Level

The BMJ authors say the three dogs reported here “take canine glucose sensing to a new level of sophistication.”

“All were clearly able to sense hypoglycemia accurately under circumstances when the patients themselves were initially unaware of falling glucose levels,” the paper states. “Formal calculations of sensitivity and specificity are not possible, but each dog showed [his or her] specific behaviors only when the patient had documented hypoglycemia.”

The BMJ authors say that Susie and Natt’s cases are unique because they detected low blood sugars even before their owners noticed the symptoms. Possible clues may include:

  • Olfactory changes (possibly related to sweating)
  • Muscle tremor
  • Behavioral alterations, such as the patient’s failure to respond to his or her dog in the usual way.

The BMJ authors suggest an extended healthcare role should now be considered for man and woman’s best friend.

“Research is urgently needed to determine whether dogs can be trained to recognize and react to early signs of hypoglycemia.”

Who’s a Good Doggie?

Several Diabetes Health readers were not surprised by the article published in BMJ, saying that their faithful companions have always been there when low blood sugars have come around.

Courtney Newton of Erie, Pennsylvania, says that her step daughter, Becka, was diagnosed with type 1 diabetes in February 2000. Their dog is a Sheltie/Jack Russell mix named Dexter.

“Dexter is my baby and [has never sat] on the couch with anyone but me,” says Newton. “If I am not in the room, he sits on the floor.”

Shortly after Becka was diagnosed, however, Newton noticed Dexter sitting quietly on Becka’s lap, trying to lick her face. At first, Newton thought this odd and ignored it. She then realized it was Becka’s snack time, so she tested her blood sugar.

“She was only 48 mg/dl,” says Newton. “She was not aware of her low blood sugar. As soon as I fed her and got her blood sugars to come back up, Dexter was back on the floor laying in his usual spot.”

A couple of weeks later, Newton recalls, Dexter was again sitting on Becka’s lap around dinnertime, trying to lick her face. Newton asked Becka if she felt low and Becka said no. When Newton took Becka’s BG reading, however, sure enough, it was 52 mg/dl.

“I thought maybe it was just a coincidence, but the next time I saw [Dexter] sitting with [Becka] and licking her face, I immediately grabbed the meter even though it was not testing time,” says Newton. “She was 54 mg/dl that time. She had not felt any of these lows herself, but the dog had.”

Newton says it has been almost a year since these episodes. Every time Dexter is nearby and Becka is low, the dog licks some part of her body.

“Becka knows that if Dexter licks her incessantly, to test her sugar and tell me or her dad,” says Newton. “Every time he has licked her, she has been low. He seems to be able to pick up anything below 60 mg/dl.”

Gregor Randall of Grants, New Mexico, has had type 1 diabetes for 26 years. Randall’s dog, Maty, whom he has had almost four years, has awakened Randall for the last three years whenever his BGs have dropped low in the night.

“At first I thought it was just coincidence; however, it has happened too many times over the last three years,” says Randall. “I don’t know if I thrash, mumble, snore, or breathe differently when my blood sugar levels drop, but regardless, she is always pushing me with her paws.”

Randall says that when he does not quickly respond, Maty, who is 40 pounds, becomes aggressive. “[She takes] a running start and hits me with both her front paws.”

Mona Vicente is a type 1 from Odessa, Florida, who has been on an insulin pump for seven years. She says she experiences about five hypos per week, typically brought on by administering too much insulin. Vicente says her chow/sheepdog, Frosty, detects her bouts of oncoming hypoglycemia.

“Frosty was a lifesaver in waking me up when I was sleeping and incurring a low blood sugar,” says Vicente.

Ann Thelemann, a type 2 from Burnsville, Minnesota, raises Dobermans. A few months back, she noticed that her smallest dog, Hannah, would begin to cry and whine for no apparent reason.

“After a few weeks, I realized that just before I did my finger sticks, she began to whine and cry,” says Thelemann. After each stick, Thelemann noticed that she would be low. She says that Hannah would lay at her feet and wait for her to say it’s okay. “On days when I would tell her, ‘It’s not good today,’ she would bring me her rawhide chew.”

Thelemann says that Hannah never lets her oversleep or miss her next testing session.

Chet Woj, a 75-year-old type 2 from Alto, Texas, has five untrained dogs of various ages. Woj says that they stay with him when he is working on the ranch. Sometimes he goes a little low and begins to get dizzy.

“When I have a hypo and head for the truck, the young and middle-aged dogs follow and jump in excitement,” says Woj.

Feline Friends Have Protective Instincts Too

Deana Przybylski of East Lansing, Michigan, has had type 1 diabetes for 30 years. She says that dogs are not the only animals that have protective instincts for their diabetic owners.

“My cat, Angora, whom I’ve had for about 15 years, woke me up on one occasion by pawing at me and meowing to get my attention,” says Przybylski. “It was a time in my life before I was married and before I was in tight control, so I didn’t have very many lows.”

Przybylski says that after her cat awoke her, she discovered she was low. Przybylski got herself out of bed to get some juice.

Christine Moye of Detroit, Michigan, has both a dog and cat. Moye, who has had type 2 diabetes for 13 years, says her animals wake her up when her BGs go low at night.

“My dog uses his nose to wake me up, and the cat bites me,” she says. “They do this until I get up.”

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Following Dr. Bernstein on Holiday

October 8th, 2008

At the beginning of 2007, we began studying guidebooks and making reservations for a long-anticipated trip to New Zealand and Australia. With limited funds and so much we wanted to do, we decided our budget would go farther if we stayed at hostels. At the same time, we were concerned about Al’s rising blood sugar scores. After visiting relatives during Christmas and celebrating the New Year, Al’s morning scores were as high as 154 mg/dl.

When Al was diagnosed in 2002, we lived in San Francisco. An endocrinologist encouraged him to regulate his blood sugar with diet and exercise rather than pharmaceuticals. Over the next six months, at the age of 72, Al closed out his business career to coincide with Ruth’s retirement. This allowed him more time for exercise.

In March of 2003, we moved to northwest Washington, near the city of Bellingham. In September of 2004, Ruth, whose career was in hospital quality management, interviewed a Bellingham endocrinologist for a column she was drafting. The endocrinologist told Ruth about an acupuncturist, Scott Paglia, L.Ac, who was helping control her diabetes. Shortly thereafter, Al began regular treatment with Scott, who had studied in South Korea and the Oregon College of Oriental Medicine. He incorporates several disciplines within his practice, including acupuncture, herbal medicine, diet, and qigong.

Discovering Dr. Richard Bernstein

Although Al continued under the care of a hospital-sponsored group physician, he also looked to this specialist for regular diabetes treatments, which consisted of acupuncture and an array of supplements. These included Equilibrium (a collection of herbs) and chromium picolinate to control blood sugars and Choleast (red yeast rice) to control cholesterol. (Later we tried the juice of bitter melon, but that was messy to prepare. Diamaxol, with a long list of ingredients including bitter melon extract and cinnamon bark, soon replaced the melon juice. Paglia’s special herbal formulation has since replaced Equilibrium.) In response to those early 2007 scores, Paglia told us about Dr. Richard Bernstein, MD. We read Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization, and The Diabetes Diet: Dr. Bernstein’s Low Carbohydrate Solution, and we immediately adopted his dietary recommendations. (Ruth got on board because she believes the diet is healthy. With the help of Choleast, her cholesterol measures have been excellent in spite of the high protein component.) In the eight weeks prior to the start of our trip, Al’s daily scores were down to an average of 106.
(See below for a list of Dr. Bernstein’s good and bad carbs)

On our trip, the choice of hostels for lodging turned out to be a good one, and not just for the budget. For anyone who envisions hostels as overrun with grungy backpackers, those in New Zealand and Australia will be a surprise. Yes, there are backpackers, but they are not grungy, nor are the premises. The facilities under the Hostelling International umbrella must meet high standards to ensure safety, cleanliness, and comfort. A subset of HI in Australia and New Zealand is the Youth Hostel Association, which, in addition to complying with the HI standards, operates hostels in an environmentally sympathetic way (see sidebar). We were very comfortable in these quarters, easily making friends with people from Europe and Asia. We usually did not significantly increase the median age. In nine weeks, we stayed in hostels 38 nights.

(See below for some tips on traveling on a budget)

Typical hostel communal kitchen, this one at the Central YHA Backpackers in Cairns, gateway to the Great Barrier Reef.

Taking control by fixing our own meals

The ability to prepare our own meals went a long way toward good control. Most hostels have stainless steel kitchens, adequate utensils, and clean dishes with food stores nearby. Generally, we cooked our own breakfasts and evening suppers, eating the midday meal out in conjunction with our explorations. Our typical breakfast was eggs in a stir-fry with shallots, courgettes (zucchini), capsicum (green peppers), and sausage or bacon. When short of time for an early tour or flight, we put lox and cream cheese on low-carb rye crackers. Our best suppers were chicken, beef, or fish with broccoli, Brussels sprouts, or green beans.

Experience underscored the need to combine exercise with diet and to maintain discipline in keeping to our Bernstein diet. When Al was careful with food and had abundant exercise kayaking in Milford Sound and Able Tasman National Park and hiking on Stewart Island, his scores stayed low. Two train trips across the New Zealand Alps and a stunning bus trip from Greymouth to Nelson were sedentary, and his scores shot up. In Tasmania, trekking for three days brought correction.

Eating at restaurants created more of a challenge than we expected – a challenge to our discipline. We like fish and chips and found them on almost every menu in both countries. Most kitchens would substitute salad for the French fries when we asked. We would say, “Just let us have a few chips,” but a full plate would come. Al would say, “I’ll just have four.” Then another four, and soon it was 24. Of course, most fish batters are heavy on carbs. We did eat a lot of salads – Caesar salads and Greek salads were ubiquitous. But what did we know about the carbs in prepared dressings?

Sometimes there aren’t a lot of choices

A few times, tours trapped us into meals with little or no choice. From Melbourne we had a very long bus tour on the Great Ocean Highway. It was worth the time because the scenery exceeds that along Big Sur in California. Lunch at a café offered fish and salad, which was fine. However, the road back was barren except for one small town where the driver/guide was enamored with a noodle house. We went across the road to a McDonald’s and bought cheeseburgers without buns, which were dry and barely adequate to stave off starvation.

We also had some pleasant surprises. Very hungry after a morning of snorkeling at the Great Barrier Reef, we were welcomed back on the catamaran by an abundant buffet including plentiful cold cuts and salad.

Another challenge was food at friends’ homes. We are members of the Affordable Travel Club, which enables us to stay with friends we have yet to meet. In return for $20 U.S. per night for a couple, members get a bed, breakfast, and an hour of orientation (see sidebar). A wonderful couple in New Zealand entertained us in their home. In addition to the expected, they took us on two tours of their community and treated us to dinner at their table, lasagna and beets. What does Al do when confronted with no choices from his preferred list (see sidebar)? He enjoyed the lasagna and limited the beets to two. Happily, the next morning his score was only 119.

Temptation beckons to us all

As our trip progressed, we continued to have good and bad food experiences. In Melbourne, our plan was to experience city life for a week. Hostel arrangements were perfect and, with a larger Greek population than any other city in the world except Athens, salads were abundant. However, at a comedy club where dinner was included in the admission, the first course was toasted bread. At an Ethiopian restaurant, Al could not resist the puffy flat bread. That evening at the hostel, a woman wasn’t able to eat all her pizza; Al helped her by consuming two slices. The next morning his score was 140.

One of the best meals we cooked was on the barby at the Outback Pioneer Hotel at the Ayers Rock Resort – steak, shrimp and mushrooms with a large salad.

At Cairns, with snorkeling, kayaking and food discipline, the scores came down—but not enough. A week later, at Ayers Rock (Uluru), Al got back on track with continued exercise and better food discipline. In addition to a communal kitchen, there was an outdoor “barby,” where every evening we cooked steak, chicken, prawns, or fish, adding some mushrooms and zucchini with lots of salad. We walked the circumference of the Rock, around the rim of Kings Canyon and into the Olgas. His last four morning scores were 110, 97, 109, and 103.

While we were satisfied that we had met the challenges on the road, we returned home recognizing the need to be more creative with food choices and more aggressive with exercise while traveling.

Now we are studying Costa Rica guidebooks that tell us beans and rice are the basis of most meals—even breakfast.

Another challenge!

Bad Carbs

Beets, carrots, corn, onions, potatoes, winter squash, yellow bell peppers, all fruits and juices, milk, yogurts, cottage cheese, grains (including rice), pasta, breakfast cereals, pancakes, bread, crackers, powdered sweeteners, candies, (especially “sugar free”), cookies, cakes, and pies.

Good Carbs

Artichokes, asparagus, bok choy, broccoli, Brussels sprouts, cabbage, celery, daikon radish, endive, mushrooms, mustard greens, pumpkin, spaghetti squash, turnips, zucchini.

Lists abridged from The Diabetes Diet, Richard K. Bernstein, M.D. Little, Brown and Company 2005

About Reservations

We made all of our own reservations except for airlines. Because hostels have a limited number of private rooms, we reserved ahead. Our itinerary was complete when we left home and we experienced no significant deviations. With few exceptions, we made arrangements via the Internet. For hostel reservations: www.hihostels.com

We made our Affordable Travel Club (ATC), reservations by email prior to departure – www.affordabletravelclub.net – and confirmed by telephone a few days prior to our visit.

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Hard Work and Determination Pay Off for Student Athlete with Diabetes

October 7th, 2008

I’ll never forget the afternoon of January 22, 2003, and the phone call that came from Derek’s pediatrician. I was just leaving my classroom that day when I noticed the light on my phone lit up, alerting me to a new voicemail. My heart stopped when I listened to the message.  The doctor asked me to call him back as soon as possible.

It all started a week before when Derek, a very healthy, active seventh grader at LaSalle Middle School, was recovering from the flu.  He appeared run down, going straight from baseball into a demanding AAU basketball schedule with very little break, and I knew something was very wrong.  He was thirsty all the time, using the restroom frequently, and he looked like he had lost weight.  So I took a urine sample in.

That day, Dr. Mark Reinertson confirmed my suspicions.  There was sugar in Derek’s urine.  Dr. Mark wanted Derek to pack a bag and go to the St. Luke’s Women and Children’s Center immediately.  After the initial shock, the first thing I asked Dr. Mark was, “Can he still play sports?”  It probably wasn’t the most logical question to ask at that moment, but I knew Derek would ask me.  Dr. Mark said, “Of course he can.  He can do anything he did before.  There are many professional athletes who have diabetes.  The key is to get it under control and keep it there.”

That afternoon was not an easy one.  When I showed up at Derek’s locker after school, he and his friends were headed to the locker room for basketball practice.   I told him the test had shown that his blood sugar was high and that he needed to check into the hospital for a few days so that they could get it to the right levels.   He just looked at me.  And when he finally spoke, the first thing he asked was, “Can I still play sports?”

The next four days at the St. Luke’s Women’s and Children’s Center were the longest four days of my life.  During our stay at the Center, Derek had to be tested constantly because they were trying to find the correct initial dosage of insulin.  He had to learn how to poke his fingers for glucose testing and how to administer insulin.  Nurses would wake us in the middle of the night to test his blood sugars.  We all met with the dietitian to learn about the importance of counting carbohydrates.

When we arrived home from the Center, I told Derek that his life would not change other than that he would have to test his blood sugar before each meal and at bedtime and take his insulin.  I told him that we weren’t going to let this get in the way of his life or let it become a “big deal” or an obstacle, and that he could do anything he set his mind to.

The first few months were rough.  It took awhile to get used to the constant testing and monitoring.  Derek’s school nurse was a tremendous help to him during those first few months.  His medication included Lantus, the 24-hour insulin taken at bedtime, and Humalog taken during the day with meals.   We soon learned that he was very sensitive to insulin and so not much was needed.  He very rarely needed more than 1 unit of Humalog at each meal.

Dr. Mark kept us up to date concerning the newest advancements in meters and insulin, and soon Derek was testing his blood sugar in his forearm and using disposable pens for his insulin, which made things much easier with his active schedule.  Dr. Mark always took a personal interest in Derek and his teams.  For an athlete with diabetes, having that kind support from your pediatrician is critical.

Basketball season was our first practice run.  How were we going to adjust Derek’s insulin to all the activity?  How would we know if his number would fall rapidly?  How would we know if it was too high?   We learned.  Derek learned.  He was very in tune with his highs and lows, and he adjusted accordingly.

Many teens diagnosed with diabetes think they have to change their lifestyles. Many stop participating in sports or other strenuous activity.  Many coaches shy away from athletes with diabetes because they don’t fully understand the condition. One misconception is that people with diabetes shouldn’t exercise for fear they will pass out or that their blood sugar will go low.   Nothing is further from the truth.  In Derek’s case, exercise helped keep his blood sugar within normal limits.  Testing before and after practices and games and staying in tune with his body was the key for him.  Having the support of the coaching staff is critical.

Derek continued to run track and play football, basketball, and baseball throughout his Xavier High School career.  He never missed a practice, and Xavier is not known for their “light practices.”  Whenever he’d feel low from all the running and conditioning, he’d run over, grab his Gatorade, take a few swigs, wait a few minutes until his number went up, and then go right back out there.  He never quit.

Derek took on a lot of responsibility himself, setting his goals high.  He was in the weight room every day, and his track coach set up training at a performance facility to help him get stronger and faster.  His growth spurt came later than most kids, but he grew into a strong 6′1″, 185-pound young man.  Xavier High School football coach Duane Schulte says, “We will be using Derek as an example at our football practices for years to come.”

Derek sustained broken bones, sprains, torn ligaments, a rotator cuff injury, hip flexor injuries, and all the typical injuries that many athletes encounter.  But he never missed a day due to diabetes.  He never allowed his diagnosis to get in the way of his goals, and he has used his diagnosis to help talk to other teen athletes about the disease and how to manage it.

Derek’s hard work paid off for him senior year.  In addition to being named to the all-metro and all-conference teams in football, baseball, and track, he earned all-state honors in track and won three state titles, setting two new state track records. He was also selected as long-time local sports announcer Bob Brooks’ Athlete of the Week.  Alluding to Derek’s future at the University of Northern Iowa, Brooks said, “The best is yet to come.”

With a month of college under his belt, Derek’s message to all young athletes with diabetes is the same message that Dr. Mark gave him almost six years ago:  “You can do anything you did before.”

Story from: Diabetes Health

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